Provider Demographics
NPI:1699108910
Name:DIONNE, ALICE DAUGHTRY (PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:DAUGHTRY
Last Name:DIONNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 SOUTHPOINT BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0976
Mailing Address - Country:US
Mailing Address - Phone:866-907-4797
Mailing Address - Fax:866-908-4797
Practice Address - Street 1:1121 E 49TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4011
Practice Address - Country:US
Practice Address - Phone:912-356-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist